title: Preventing diabetes blindness: cost effectiveness of a screening programme using digital non-mydriatic fundus photography for diabetic retinopathy in a primary health care setting in South Africa.
abstract: BACKGROUND
  South Africa like many other developing countries is experiencing an epidemiologic transition with a marked increase in the non-communicable disease (NCD) burden. Diabetic retinopathy is the most common cause of incidental blindness in adults. A screening programme using a mobile fundal camera in a primary care setting has been shown to be effective in the country. Information on affordability and cost is essential for policymakers to consider its adoption.
  
  
  METHODS
  Economic evaluation is the comparative analysis of competing alternative interventions in terms of costs and consequences. A cost effectiveness analysis was done using actual costs from the primary care screening programme.
  
  
  RESULTS
  A total of 14,541 patients were screened in three primary healthcare facilities in the Western Cape. Photographs were taken by a trained technician with supervision by an ophthalmic nurse. The photographs were then read by a medical officer with ophthalmic experience. A cost effective ratio of $1206 per blindness case averted was obtained. This included costs for screening and treating an individual. The cost just to screen a patient for retinopathy was $22. The costs of screening and treating all incident cases of blindness due to diabetes in South Africa would be 168,000,000 ZAR ($19,310,344) per annum.
  
  
  CONCLUSIONS
  Non mydriatic digital fundoscopy is a cost effective measure in the screening and diagnosis of diabetic retinopathy in a primary care setting in South Africa. The major savings in the long term are a result of avoiding government disability grant for people who suffer loss of vision.
authors.affiliation: Gauteng Health Department, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa. drtaskeenkhan@gmail.com
authors.forename: Taskeen
authors.initials: T
authors.lastname: Khan
authors.forename: Melanie Y
authors.initials: MY
authors.lastname: Bertram
authors.forename: Ruxana
authors.initials: R
authors.lastname: Jina
authors.forename: Bob
authors.initials: B
authors.lastname: Mash
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
authors.forename: Karen
authors.initials: K
authors.lastname: Hofman
mesh_terms: D003362:Cost-Benefit Analysis; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics*; D005654:Fundus Oculi; D006801:Humans; D010781:Photography / Q000191:economics*; D013019:South Africa
keywords: Blindness; Cost effectiveness; Diabetic retinopathy; Digital fundoscopy; Mobile camera; Primary care setting; Screening for retinopathy